Organization
PROSPEROUS HEALTH SAN DIEGO, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GERALD R SHIREY III (PROGRAM DIRECTOR)
(858) 500-8000
Entity
Organization
Contact information
Practice address
9909 HUENNEKENS ST STE 110, SAN DIEGO, CA 92121-2928
(619) 669-3295
Mailing address
9909 HUENNEKENS ST STE 110, SAN DIEGO, CA 92121-2928
(858) 500-8000
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
324500000X
Substance Abuse Rehabilitation Facility
—
—
Other
Enumeration date
02/27/2025
Last updated
02/18/2026
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